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ORIGINAL RESEARCH

IMPROVING HEALTCARE SERVICES USING MOBILE TECHNOLOGY:

NEEDS AND EXPECTATION ASSESSMENT FOR THE DEVELOPMENT OF
MOBILE HEALTH APPS FOR MENTAL HEALTH SERVICES IN
TECHNOLOGY

Slametiningsih, Ninik Yunitri, Hendra. Nuraenah, Abdu Rahim Kamil

Universitas Muhammadiyah Jakarta
Email: [email protected], [email protected], [email protected],
[email protected], [email protected]

ABSTRACT Keywords

The number of electronic health applications is increasing, including those that can be
used for mental health. Previous studies showed that, use of several applications
provides great benefits for mental health and greatly increases accessibility to mental
health services. The objectives of this study were to assess needs and expectations of Caregivers,
patients with mental disorder and a broad group of stakeholders with the expected end Mental
product being a well-functioning user-centered technology-based tool for mental Health,
disorders. The research was carried out by involving 80 patients with schizophrenia Mobile App,
and 74 family’s caregivers in health services and local offices of health services in five Mobile
cities of Indonesian capital city, Jakarta. This study was conducted through self- Medical
administered questionnaires from December 2017 to July 2018. A descriptive statistic Education,
using proportion was used to present the data. The results indicated that patients Technology
needed information relevant to disease, patient care, check-up schedules and
consultation with health workers. In addition, patients also wanted to get information
on job vacancies due to many of them were unemployed and rehabilitation programs
carried out by local health services. This study highlighted the needs to develop a
mobile-based application for continuity of mental health services in the community.

INTRODUCTION receive a treatment for their mental health

problems (Ministry of Health of Republic of
Mental health problems are a major
Indonesia, 2018). The main reasons for lack
public health issues worldwide and
of treatment for mental health problems
accounted for 8.5% of premature death and
were lack of awareness about mental health,
disability (Murray et al., 2015) . Around
stigma related to mental illness that affected
6.1%-9.8% of Indonesians suffer from
the health seeking behaviour, lack of
mental disorders such as schizoprehnia,
appropriate mental health services and
depression, and other emotional problems
shortage of trained mental health
(Ministry of Health of Republic of
professionals (Thornicroft et al., 2009;
Indonesia, 2018). However, the majority of
world health organization, 2001). These
mental disorders receives less attention or
conditions are more severe in rural
undertreatment, particularly in developing
populations (Armstrong et al., 2005),
countries, such as Indonesia, only 9%

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especially in regions with particularly poor and security expectations. In Indonesia, the
infrastructure and resources for health care implementation of Telehealth or Telenursing
delivery in general, with almost no capacity is not considered optimal yet since there are
for providing mental health care. a small number of health practitioners
The evolution of the Internet as a providing consultation and information to
worldwide connectivity tool has become the patients by phone or facsimile machines
key to information and communication (Hariyati & Sahar, 2012).
technology. By taking advantage of this Within this background, we argue
opportunity, people have designed platforms that a user-centered improvement strategy is
that make it possible to share information wanted to make certain that mobile health
and interactions between professionals. apps developments are relevant and useful,
Nowadays, it’s not only used for business particularly for sufferers with mental illness
but also in healthcare systems for and for household caregivers. A variety of
prevention, care or curative, and equipment is designed to tackle specific
rehabilitation. The number of electronic challenges and in order to reach their
health applications is increasing, including expectation they have to match with the
those that can be used for mental health expectations of the users whilst being
(Bakker & Kazantzis, 2016).Previous without usability problems (Hoyt et al.,
studies have shown that the use of several 2013). Efficacy, satisfaction, and
applications provides great benefits for effectiveness are key elements of the
mental health and greatly increases usability of technology-based equipment
accessibility to mental health services and these factors have to be fulfilled for tools
(Research Guidance, 2016). A meta-analysis to be tailor-made to meet the needs of users,
study reports that mobile-apps for mental mainly in mental health fields (Agha et al.,
health showed a positive effects on 2013). Potential user necessities need to be
symptoms of depression, anxiety, and other the fundamental focus for cellular software
mental health conditions (Donker et al., interface design, especially in clinical
2013). Utilization of digital technology, education. Required interface elements need
including mobile applications could reduce to dominate the design of the rest of the
the healthcare cost, improve the relationship system (Peck et al., 2000). However, until
between patients and family with healthcare now in Indonesia there is no specific cellular
professional , resolve geographical barrier, application for patients with mental
and reduce stigma in mental health services disorders or families caregiver. In addition,
(Firth et al., 2017). With the increase of instructions and directions regarding the use
computer literacy and medical knowledge of the application are not yet available.
available on the internet in the world, health Therefore, in order to develop a useful
care professionals must be well prepared to mobile apps, it is important to determine the
cope with changing patient behaviors and needs of patients, health care providers,
knowledge (mental health commision of family caregivers, volunteers and the nature,
canada, 2014). characteristics, and content of the current
Unfortunately, the development of mobile apps (Kaplan, H.I. & Sadock, 2010).
information and communication technology In this regard, this study was
cannot be utilized in many low and middle conducted in the Indonesian capital city as
income countries, such as Indonesia, even part of project of Telenursing Me-Co Care
though the demand for patients and medical for mental health care. This project used task
practices continues to increase. Although a shifting that was supported by a mobile
large number of technology-based tools are technology based mental health services
widely available, most of them are not delivery model for health education,
adapted to local settings and users have not managing and rehabilitation of patients with
been consulted for the development of tools mental disorders. The main objective of this
(Bridges et al., 2011). A previous study has study was to assess the needs and
shown that some applications lack expectations of patients with mental
documentation, or do not meet user privacy disorders and a broad group of stakeholder

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with the expected end product being a well- Ethical considerations
functioning user-centered technology-based This approval was received from the
tool for mental disorders. Independent Review Committee of affiliated
university (079/KEPK/UMJ/III/2019).
METHOD Informed written consent was obtained from
The needs and expectation all participants and data were collected
assessment was conducted in collaboration according to the Declaration of Helsinki on
with a team from the department of nursing ethical research. Approval for conducting
and engineering of Universitas the project was obtained from all the local
Muhammadiyah Jakarta, Indonesia. This administrations.
study was conducted through self-
administered questionnaires where possible Data analysis
from December 2017 to July 2018. All data were cleaned by the data
management team. Most of the coding was
Settings and sample predefined at the time of developing the
The research involved the Health electronic data capture tools by the software
Services and Local Offices of health services developers in consultation with the
in five cities of Indonesian capital city, researchers. A descriptive statistic using
Jakarta, including Central Jakarta, East proportion was used to present the data.
Jakarta, North Jakarta, West Jakarta, and
South Jakarta. For reasons of efficiency in RESULTS
collecting users’ requirements, we selected a About 36.2% of patients with
participants including 80 patients with schizophrenia were ages from 26-35 years
mental disorders confirmed from their old. The majority of respondents were males
medical records and age above 20 years old, (65.5%) and graduated from senior high
74 family members who live with a patient school (61.2%). The majority of family
with mental disorders and have role as a caregivers were ages from 46-55 (35.1%)
decision maker in their family. A and females (78.3%) with low education
convenience sampling technique was used in (graduated from elementary school)
this study. (78.3%). 47.3% of family caregivers were
The data were collected using the patient’s biological mothers (Table 1).
questionnaires self-developed by the Around 83.7 answered that patients
research team through an extensive literature know about their disease and 100% family
search and expert review. After the caregivers know their family disease
calculation, the mean item content validity diagnosis. The majority of patients
index (I-CVI) was .705 and In the current diagnosed with hallucination (86.2%) as
study, alpha coefficient showed acceptable perceived by the patients but from family
internal reliability (α = .675). Participants caregivers’ perspective, 87.8% perceived the
fill out the questionnaire by checking the disease is associated with a previous history
“Yes or No” box. The questionnaire was of disease in family (Table 2). About one
asked the information about the disease and third of the patients had stopped taking a
treatment, call center, job opportunity medication due to lazy to make medicine
information, health information, and (39.3%), followed by bored and forgot to
consultation, insurance procedures, take medicine (17.8%) (Table 3). About
perspectives on availability of medical 80% public health service provided care for
information, and updates potentially patients with mental health disorders and
provided via mobile-based technology. The majority of the patients perceived
questionnaire was analyzed per item for the satisfaction with the quality of care delivered
frequency. (Table 4).
Table 5 describes the content
needed on the mobile app based on patients’
perspectives. About 91.2% needed

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rehabilitation program, 68.7% perceived Table 2. Frequency Distribution Based on
need of job vacancy information, 63.7% Patients' Health History
needed rehabilitation activities in their Variable Patients’ Caregivers’
environment, 61.6% needed a platform for perspective perspective
consultation online, especially which (n=80) (n=78)
n % n %
relevant to follow up schedule. Patients also Knowing about the
required the information about the disease diseases 67 83.7 74 100
and medicine that they took routinely. Yes 13 16.2
No
Base on the family caregiver’s Type of disease
perspective, they need the information about Family Medical 3 3.7 65 87.8
call center, information about the insurance. History 69 86.2 2 2.7
Hallucination 3 3.7 2 2.7
Around 75.6% of caregivers choose to go to Social isolation 2 2.5 4 5.4
health service center as a response to the Low Self-esteem 3 3.7 1 1.3
patients' recurrences. However, 74.3% of Suspicion

participant knew about the availability of

call center and with the majority of them Table 3. Frequency Distribution Based on
(67.2%) frequently contacted the call center Medical Treatment Record (n=80)
of local government clinic.
Variable n %
Table 1. Demographic characteristics of Stop taking the
studied participants medicines 28 35.0
Yes 52 65.0
No
Variable Patients Caregivers
(n=80) (n=78) Reason of stop taking
the medicines: 4 17.8
n % n % Bored 1 3.6
Age (years) Wanted to free from 2 7.1
13-16 1 1.2 - - the medicines 11 39.3
17-25 11 13.7 1 1.3 Medicines ran out 2 7.1
26-35 29 36.2 4 5.4 Lazy to take medicine 5 17.8
36-45 22 27.5 14 18.9
46-55 14 17.5 26 35.1 Far from home 3 10.7
56-65 3 3.7 19 25.6 Forgot to take the
>65 - - 10 13.5 medicines
Gender nausea
Male 50 62.5 16 21.6
Female 30 37.5 58 78.3
Education level
No formal - - 4 5.4
education 11 13.7 24 32.4
Elementary 14 17.5 16 21.6 Table 4. Availability of health care services
School 49 61.2 24 32.4 for mental disorders (n=80)
Junior High 6 7.5 6 8.1
School Variable n %
Senior High Availability of health services
School in the region - -
Higher Education Yes 80 100
Institute/Collage No
Health service quality
Poor 3 3.7
Sufficiently satisfactory 41 51.2
Satisfactory 36 45.0
Availability of online health
services: 64 80.0
Yes 16 20.0
None

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Table 5. Content needs on the Online Mental DISCUSSION
Health Service Application based on This study highlighted the need of
patients’ perspective (n=80) patients with schizophrenia about their self-
Variable n % management including disease-related
Need for Job Information 55 68.7 information, consultation, medication, and
Expectation of the type of work rehabilitation activities. One of the goals for
needed 8 10.0
Motorcycle/taxi driver 3 3.7 the future smartphone application is to
Tailor 10 12.2 provide information on disease in general
workshop 4 5.0
salon 6 7.5
and to cope with disease-related medicines
cleaning service 4 5.0 and relapses. Participants also expect the
laborer 2 2.5 application to provide an information to
housemaid 18 22.5
others increase their knowledge and awareness
about coping with the disease burden in
Ever been rehabilitated 17 21.2 everyday life, which is often impaired by
Need for rehabilitation 51 63.7
activities in the environment
common myths and rumors. Previous study
reported that patients with knowledge
Need for a consultation 73 91.2
program deficits or low health literacy are expected to
Information required from benefit most from mHealth interventions
consultants: 45 61.6 (Whitehead & Seaton, 2016). Previous study
Check-up Schedule 17 23.2
Taking medicine schedule 7 9.5 reported that the use of mobile–based
Rehabilitation schedule 4 5.4 technology could increase the proportion of
Treatment schedule
mental health services use by individuals
Required for online mental
health: 15 20.5 who were suffering from mental health
Information on medicines 18 24.6 disorders. Therefore, future studies need to
Information on illness 2 2.7 address the health literacy among patients
Information on health 10 13.6
insurance 21 28.7 with schizophrenia and family caregivers.
Treatment record/history 6 8.2 Participants wish for an application
Control schedule 3 4.1
Rehabilitation schedule
feature that offers specific information on
The latest control rehabilitation and job vacancies with certain
skills such as transportation services,
cleaning services etc. This study showed that
Table 6. Content needs on the Online Mental
to develop mobile application for mental
Health Service Application based on
health need a comprehensive content that not
caregivers’ perspective (n=78)
only focus on disease-specific information
Variable n % but also information related to social and
Families' response in facing environmental aspects. Thoughtful mHealth
recurrences 9 12.1
Reporting to Head of 56 75.6 research will help create resources that can
Neighborhood Unit 9 12.1 have a huge impact on the lives of people
Go to a health service coping with problems of mental health. Yet
center
Others conducting mHealth research with mobile
Availability of a call center 55 74.3 phones is complex, need to consider how to
Call centers frequently
contacted 6 11.0
translate clinic intervention to mobile-based
Cadre 37 67.2 intervention design and delivery strategies,
Local government clinic 9 16.3 taking into account consumer population
Health worker 2 3.6
Police 1 1.8 preferences and deployment environment.
Nearest family member Our study reported that family care
Knowledge of the use of givers had good knowledge regarding the
health insurance 72 97.2
Know 2 2.7 illness of their family members. With
Do not know respect to the mobile-based application that
was going to be developed, the family
needed information on the disease and early
treatment when the patient experienced

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recurrence, information on relevant call Social Support, Family Well Being,
centers, and information on health Quality of Parenting, and Child
insurances. However, the data collected was Resilience: What We Know. Journal
limited to the implementation of health of Child and Family Studies, 14, 269–
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Indonesia yet (Ministry of Health of Developments”. JMIR Mental Health,
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of community mental health nursing, Odegard, P., Maki, I. V, &
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needs and expectation of patients with based mental health interventions for
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showed that patients with schizoprenia need Hariyati, R. T. S., & Sahar, J. (2012).
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